Concurrent occurrence of subgaleal haematoma (SGH) and orbital subperiosteal haematoma (OSPH) is an unusual post-traumatic phenomenon. It is especially seen in cases of massive SGH. This report is a review, illustrated with a personal clinical experience, of this clinical disease association. Extensive literature review using the PubMed search engine for all cases of blindness from SGH and OSPH in the English language was conducted for this report. Vision-threatening complications of massive traumatic SGH that is associated with OSPH are rare but well described. The resulting orbital bleed most commonly involves the extraconal orbital roof. It is essentially an orbital epidural haematoma. Its aetiopathogenesis is that of an orbital space occupying lesion (SOL) causing clinical evidence of raised intraorbital pressure (IOP) including chemosis, proptosis, ophthalmoplegia, exposure keratopathy and orbital cellulitis and blindness. The visual impairment is usually temporary and responds well to prompt intraorbital decompression. However, permanent blindness ensues if suboptimal treatment including missed diagnosis and or delayed treatment is offered.

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Background/Introduction: Macrophthalmia and microphthalmia are cardinal signs of many orbito-ocular and systemic diseases which are seen in northern Nigeria. Some cases of refractive error may also be directly related to the ocular axial length (AL). The need for an imaging parameter that will aid their early diagnosis is necessary, as visual compromise is a major consequence if they are not diagnosed and managed appropriately. Aim and Objectives: To use magnetic resonance imaging, to determine the normal AL of the eyeball and to establish the association, if any, between AL and inter-zygomatic line (IZL), age and sex. Materials and Methods: The study was conducted over a 6-month period (29^th November 2011 to 28^th May 2012) at the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. The anterio-posterior dimension of the globes (AL) and the length of IZL were measured at the level of the lens for 340 normal ocular globes of 170 patients on T₁-weighted MR images. Results: The normal ranges for ocular measurements were as follows (mean ± SD): AL of the right globe, 23.32 ± 1.34 mm (range 22.0–24.7) and AL of the left globe, 23.29 ± 1.22 mm (range 22.10–24.51). The length of the IZL was 103 ± 4.78 mm (range 98.2–107.78). All measurements in male patients were significantly higher than those in female patients (P < 0.001). Conclusion: The results obtained from this study may help ophthalmologists, radiologists and other clinicians to quantitatively evaluate patients with macrophthalmia, microphthalmia and/or refractive errors.

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To report a case of bilateral orbital cellulitis in a conscious 11-year-old Nigerian girl and the management challenges. Bilateral orbital cellulitis secondary to rhinosinusitis is uncommon but has been reported in the literature in other countries where the diagnosis was made with the aid of necessary tools such as the computerized tomography scan among others. In this case, the challenge associated with the management of the index child is a reflection of the difficulties encountered in the treatment of patients in the developing countries and the importance of a good clinical judgment, early diagnosis, and prompt intervention in the management of bilateral orbital cellulitis. This is a case report of an 11-year-old Nigerian girl of the Igbo tribe. She presented with painful progressive protrusion of the eyeballs and swelling of the lids of 3 days duration. The left eyeball protruded 2 days after the right with no associated history of altered sensorium. A working diagnosis of bilateral orbital cellulitis secondary to rhinosinusitis was made. She was placed on parenteral and topical antibiotics until she recovered. Bilateral orbital cellulitis occurring in a conscious child is uncommon. Prompt and specific treatment should be started empirically, especially in developing countries where the facilities for investigation may not be available or the patients may be financially handicapped. This is particularly important to prevent the possible loss of vision and severe life-threatening complications. This study will be of interest particularly to the ophthalmologists, the otorhinolaryngologists, and the pediatricians.

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Background: Ocular trauma is an important public health hazard especially in the developing countries. The objective of the study was to determine the pattern of ocular injuries in patients who presented at the eye clinic of Federal Medical Center, Gusau, Zamfara State, Nigeria. Materials and Methods: A prospective study was conducted between 1^st January and 31^st December, 2008. All consecutive, consenting patients with ocular trauma were interviewed with the aid of an interviewer-administered questionnaire and underwent a detailed eye examination. Results: There were 121 patients in the study with 101 (83.4%) males and 20 (16.6%) females. The most common location of ocular trauma was more on the road (32.2%); road traffic accident (RTA), followed by home/domestic injury (23.1%) and at work in 15.8%. The most common anatomical site of injury was the cornea (40.6%) followed by the lids (17.5%) and the iris (14%). Conclusion: In this study, RTA was the most common cause of ocular trauma followed by domestic injuries. There is need for community education on preventive measures such as use of safety seat belts while driving and importance of supervising playing children at home.

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Purpose: To determine the prevalence and determinants of corneal blindness in a semi-urban population of Southwest Nigeria. Materials and Methods: This population-based, cross-sectional study was conducted over a period of two months from 3^rd March to 30^th April 2014. A multi-stage sampling method with probability proportional to size procedure was used to select 1002 participants. The study involved obtaining information from the participants on demographic data and ocular history suggestive of the causes of corneal blindness using interviewer-administered questionnaires. Ocular examinations of the anterior and posterior segments of the participants were performed using pen touch, magnifying loupe, slit lamp and direct ophthalmoscope. The data collected were analyzed using the Statistical Package for Social Sciences software version 22. Summary statistics was presented using frequency tables, charts, means and rates. The level of statistical significance was set at 5%. Results: There were 1002 participants (410 males and 592 females). Their age range was 5–92 years with a mean age of 43 (±17) years. Eleven participants (13 eyes) had corneal blindness with a prevalence of 1.1% (95% confidence interval: 0.5–1.7). Corneal blindness accounted for 9.6 and 20.4% of bilateral and unilateral blindness, respectively. The prevalence of corneal blindness in the communities was greater among the male respondents, the older age groups, the farmers and the participants with lower educational status. The major causes of corneal blindness in the study were post-microbial keratitis (36.4%) and trauma (27.2%). Conclusion: Corneal blindness is still a major cause of both unilateral and bilateral blindness. Preventive measures for corneal blindness need to be further strengthened. In addition, affordable and accessible corneal surgery facilities should be established.

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Aim: To analyze the efficacy and outcomes of punctal occlusion with 5-0 Prolene suture material for the treatment of dry eye. Materials and Methods: A total of 20 patients with moderate and severe dry eyes, recalcitrant to maximal medical therapy, underwent temporary punctal occlusion with 5-0 Prolene suture material. The lower punctum was dilated with a punctum dilator. Prolene suture pieces with sizes ranging from 1.5 to 2 mm were made. A total of 8–10 such pieces were inserted into the lower punctum. The patients were followed up on the 1^st, 3^rd and 6^th months, and their values of Schirmer’s test, Teat film break up time and ocular surface staining were compared with the baseline values, which were taken as control. Results: Punctal occlusion has been shown to improve the objective and subjective measures of dry eye. The patients obtained significant relief from the symptoms of dry eye by the end of 2 months. Recurrence of symptoms was noted at 6 months. Statistically significant difference was noted in the Schirmer’s and TBUT values between the baseline and at the end of the 3^rd and 6^th months. However, this difference was less than that at the end of the 1^st month. The corneal surface staining was improved at the end of the 1^st month, but it again began to deteriorate by the end of the 6^th month. Conclusion: Prolene is a biologically inert, efficacious and cheaper alternative to collagen punctal plug. Occlusion of the puctum with a temporary punctal plug such as a Prolene suture material helps an ophthalmologist to plan for permanent punctal occlusion. Improvement in the eye condition after the use of temporary punctal occlusion suggests that the patient may benefit from permanent punctal occlusion.

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Background: The emergence of intravitreal antivascular endothelial growth factors (antiVEGF) has revolutionalised the treatment and prognosis of many retinal diseases. Aim: To determine the indications and treatment outcomes for use of intravitreal antiVEGF agents in retinal diseases among patients in a tertiary hospital in Benin City, Nigeria. Materials and Methods: The case folders of patients, who had intravitreal injections of antiVEGF from January 2012 to December 2014, were analysed. Data retrieved included age, sex, indication, type of intravitreal antiVEGF used, number of injections, visual acuity, treatment outcomes, complications and follow-up duration. Results: There were 27 patients, consisting of 12 males and 14 females, with a mean age of 61.8 ± 7.8 (range 46–76) years. Intravitreal antiVEGF were administered in both eyes of 14 (51.9%) patients. Bevacizumab and ranibizumab were utilised in 36 (87.8%) and 3 (7.3%) eyes, respectively. Two (4.9%) eyes had both bevacizumab and ranibizumab during treatment switching from ranibizumab to bevacizumab. A total of 72 injections were administered during the study period with a mean number of 2.4 ± 1.5 (range 1–8) injections administered per eye. The most common indication was diabetic macular oedema in 17 (40.5%) eyes. After treatment, vision improved in 21 (51.2%) eyes and was unchanged in 10 (24.4%) eyes. Eyes, which initially improved, worsened in 10 (24.4%) patients following cessation of treatment. The most common complication encountered was subconjunctival haemorrhage in 15 (36.6%) eyes. The mean duration of follow-up was 12.4 ± 6.8 (range 4–26) months. Conclusion: Intravitreal antiVEGF are effective in the management of a vast array of retinal conditions. However, the burden of care including costs and the need for multiple injections are still drawbacks that require an alternative treatment strategy.

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A rare case of congenital anomaly of the optic disc is presented to draw attention to the occurrence of this anomaly in rural India. The typical case presented with excavated, enlarged colobomatous optic nerve head filled with glial tissue surrounded by peripapillary pigmentary abnormalities. Ocular complications in affected eye may include strabismus, retinal detachment and reduced visual acuity. Contralateral eye may also be involved as a part of anterior chamber cleavage syndrome. It may have systemic associations as in Aicardi syndrome. Therefore, the comprehensive ophthalmic examination of both eyes using various ocular investigations for its early diagnosis and of associated systemic disorders and complications is essential.

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Herpes zoster ophthalmicus (HZO) is rare in children especially those who are immunocompetent. We reported a case of HZO in a healthy 3-year-old girl with no history of exposure or underlying immune-compromising systemic disease. She developed severe ocular complications after treatment. Both parents were non-reactive to human immunodeficiency virus (HIV) I and II.

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Purpose: Globally, amblyopia remains a common cause of visual impairment in children. Early screening and treatment is necessary to prevent permanent visual loss. This study aimed to evaluate the prevalence, etiologic factors, and characteristics of amblyopia among rural, public primary school children in Ijebu East Local Government Area (IELGA) of Ogun state, southwest Nigeria. Materials and Methods: The study was a cross-sectional descriptive study conducted among pupils of randomly selected public primary schools in IELGA from 27^th October to 7^th November 2014. Data on sociodemographics, ocular history, and ocular examination were collected. Descriptive and comparative analyses were performed. Values of P < 0.05 were considered statistically significant. Results: There were 1180 public primary school pupils enrolled for the study. The data of 1153 pupils were analyzed giving a 97.7% response rate. The mean age was 9.2 ± 2.8 years with age range from 4 years to 16 years. There were more female students (586; 50.8%) with a male-to-female ratio of 1:1.03. Majority of the pupils were from the Yoruba ethnic group (819; 71.0%) and from basic one academic class (236; 20.5%). Six of the examined pupils were found to have amblyopia, giving a prevalence of 0.5%. The following three types of amblyopia were seen in this study: anisometric amblyopia (2; 0.17%), ametropic amblyopia (2; 0.17%), and strabismic amblyopia (2; 0.17%). Three pupils had unilateral amblyopia while three had bilateral amblyopia. All amblyopias were classified as mild-to-moderate amblyopia. Conclusion: The prevalence of amblyopia among these rural school children was low. However, because children with amblyopia could have a lifetime of blindness ahead of them, the number of “blind person years” in those whose blindness started in childhood is enormous. Early screening is required to prevent the attendant consequences of socioeconomic burden following visual impairment in this vulnerable subsection of the Nigerian rural populace.

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Blindness secondary to odontogenic orbital cellulitis is a rarity. We report a case of a 38-year-old man who presented with facial swelling and orbital pain. Examination revealed right orbital purulent discharge, nil light perception in the right eye and the presence of a grossly carious ipsilateral maxillary molar. Investigations revealed no underlying systemic condition. Aggressive surgical and medical intervention was instituted, which resulted in disease resolution. However, vision in the right eye was not recovered. Dental infections may lead to blindness; therefore, dental infections should be promptly treated.

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